In the advanced (minimally invasive) surgery, instruments are used for instance for a chip-removing or material-removing machining of bones, cartilages etc., for example with arthroscopic operations, in spinal surgery and similar orthopedic treatments, which comprise an ergonomically shaped handpiece and an optionally exchangeable tool (such as a milling cutter, turning knife, polishing head, etc.) which is rotatably supported in the handpiece at its distal end so as to be able to be driven. Depending on the designated use and the intended rotational speed, the tool drive is a hydraulic, pneumatic or electromotive drive which is in operative connection with the tool via a torque transmission train (such as a gearing mechanism and/or a number of shafts which may possibly be coupled to one another) within the handpiece. The drives may be integrated in the handpiece or implemented as external drive units which are coupled to the handpiece via energy supply lines or torque transmission lines (e.g. flexible and elastic shafts); in this case, the handpiece essentially serves only for accommodating the gearing mechanism or torque transmission train.
Tubular handpiece shafts are usually connected/mounted to the distal ends of the handpieces, i.e. the ends facing the body, and depending on the intended purpose said handpiece shafts have different shaft lengths and shapes to advance to various places within a patient body. By way of example, there are straight or bow-shaped handpiece shafts or preferably those which are cranked (angled) in the zone where they are fitted to the handpiece; in said handpiece shafts, a torque transmission rod or shaft (in the following: torsion rod) is always supported. Said rod/shaft has to be sufficiently stiff (resistant to torsion) in order to be able to transfer the required torque to a tool which is distally inserted therein or formed thereon (i.e. the rod needs to have a sufficiently high torsional stiffness), but also has to be sufficiently flexible, i.e. possess a certain bending flexibility, in order to be capable of following the curvatures of a (not straight) handpiece shaft route also in the presence of a rotary movement.
For connecting the tool to the torsion rod supported in the handpiece shaft, a shaft coupling is provided for detachably receiving a tool shaft. In such arrangement, however, one problem is to provide such a shaft coupling for the possibly exchangeable tool within the small-diameter handpiece shaft with such a design that a safe and long-lasting function of the surgical instrument is ensured even with such small handpiece shaft diameters and high rotational speeds, especially also with long handpiece shafts. Moreover, also the handpiece shaft should be exchangeably received on the handpiece in order to be able to realize different shaft lengths and shapes with a single handpiece. Here, the crucial point is the additional detachable torque-based connection between the gearing mechanism/torque transmission train accommodated in the handpiece and the torsion rod supported in the shaft; on the one hand, said connection is required to be closed in an easy and simple manner and on the other hand it is supposed to transfer sufficiently high torques. Finally, the operability of the instrument (including the process of exchanging a tool and/or a handpiece shaft) should be simple and safe.
A surgical instrument of this kind and in particular a handpiece of such a surgical instrument is known from EP 1 598 023 A2, for example.
In this special case, the known handpiece consists of a sleeve-shaped handle portion (which could have any other handle shape, of course) which has a proximal end (facing away from the body) to which a line package for power supply (pressurized air, electrical current or hydraulic pressure) can be connected and a distal end (facing the body) to which a handpiece shaft is screwed (optionally in exchangeable fashion) by means of a union nut. The handpiece shaft has an outer and an inner shaft jacket which also serves for slidably and rotationally guiding the torsion rod inserted therein. In the axial direction, the inner shaft jacket is subdivided in several segments between which one ball bearing each is inserted in the outer shaft jacket, said ball bearings supporting the torsion rod on the outer shaft jacket. A tool, preferably a milling head is fixed or formed on the distal end of the torsion rod.
As can be taken from this reference, the tool is basically formed from an engagement or cutting head and the torsion rod, which are connected to each other in one piece. Thus, the coupling between the tool and the gearing mechanism/torque transmission train within the handle portion is achieved exclusively in the area of the union nut. This means that the tool is a custom-made article which is especially adapted in its length to said one, specific handpiece shaft and cannot be used for other handpiece shafts having another length. It is obvious that such a design principle is expensive to manufacture as well as in providing it, as a matching tool has to be present or to be stored for each handpiece shaft.
The attached FIG. 1 schematically illustrates the longitudinal section of such a known surgical instrument in which a tool has already been inserted.
According to that, the known tool comprises the tool shaft which projects out of the distal end of the instrument shaft or handpiece shaft so as to be rotatable and has its distal end provided with a cutting head (not shown in further detail). The proximal tool shaft end illustrated in FIG. 2 in an enlarged view is provided with the known tool shaft in the form of a sharpened wedge shape, forming two inclined surfaces (corresponding to a so-called dihedron) facing away from each other and serving for introducing a torque. On the distal end portion of said wedge shape, the tool shaft is formed with a circumferential groove which serves as an axial locking means as will be described below.
In accordance with the above tool construction, the known handpiece has its distal end provided with an axially shiftable cap sleeve by means of which the instrument shaft or handpiece shaft can be coupled to the handpiece in torque-proof fashion. Within the handpiece in the area of the cap sleeve, a rotatably supported accommodation tube is provided which has its proximal end portion put into a rotary spindle and secured in torque-proof fashion therein by means of a cross pin.
Formed on the distal end of the accommodation tube are at least two diametrically opposing holes which have clamping balls movably inserted therein. A closure or clamping sleeve is supported so as to surround the outside of the accommodation tube and so as to be axially shiftable; in a first axial position, said clamping sleeve unblocks the clamping balls so that they can move radially outwards, and in a second axial position it urges the clamping balls in radially inward direction. For the manual operation of the clamping sleeve, a slider is also provided which is supported on the outside of the handpiece and connected to the clamping sleeve by means of a driving pin. In this context, it is to be noted that the slider is spring-biased toward the second axial position of the clamping sleeve.
As can be further taken from FIG. 1, a torque transmission bolt is provided within the accommodation tube so as to be relatively shiftable in axial direction; said bolt comprises a distally arranged, axially extending wedge-shaped notch which can be made to engage the wedge shape of the tool shaft for torque transmission. The bolt is biased in distal direction by means of a spring and is secured in the accommodation tube by a cross pin in torque-proof manner.
According to said constructional design, the known tool—with its tool shaft ahead—has to be inserted into the handpiece shaft at the distal tip thereof and has to be axially shifted therein toward the accommodation tube until the proximal tool shaft wedge (dihedron) rests against the clamping balls. At that moment, the clamping sleeve is axially shifted to its release position via the slider, so that the clamping balls are displaced by the tool shaft wedge in radially outward direction and in this way is able to further advance into the accommodation tube until it comes to lie in the notch of the torque transmission bolt. If the slider is released again, the clamping sleeve (driven by the pretensioning spring) automatically returns to its clamping position in which the clamping balls are urged radially inwards into the circumferential groove on the tool shaft and hence lock the tool shaft in axial position. In this way, a torque can be transferred from the rotary shaft through the cross pin, the accommodation tube, the further cross pin and the torque transmission bolt (torque transmission train) to the tool shaft.
The known construction described above, however, has some particular features which are in need of improvement:
The described cross pin connections result in a local weakening of the material in the torque transmission bolt as well as in the accommodation tube and also in the rotary shaft within the handpiece. In addition, the cross pins are quite thin and therefore prone to breakage. As a whole, the transferable torque is limited.
Furthermore, the wedge shape of the tool shaft is not very suitable for transferring high torques, as the axially acting force amount results in the tool-side wedge shape becoming disengaged from the notch of the torque transmission bolt. Moreover, it has to be expected that the accommodation tube is spread apart in the area of the notch.
Finally, the entire coupling-related mechanic system for connecting the tool shaft to the gearing mechanism/torque transmission train within the instrument handpiece has been displaced to the area of the cap sleeve where there is still a sufficient amount of radial clearance for receiving the coupling elements. As a consequence, the tool shafts have to span the full length of the instrument shafts or handpiece shafts. This means that special tools are required for each handpiece shaft.